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Barbaro strikes problems with new cast

July 4, 2006

Dr. Dean Richardson walks Barbaro to operating room. He received another new cast on Wednesday, two days after it was replaced.

Photos: Sabina Louise Pierce/University of Pennsylvania

Barbaro's cast was changed again on Wednesday, just after an earlier change on Monday. Dr Dean Richardson, Chief of Surgery, replaced the cast.

"Barbaro was not comfortable with the second cast, so we decided it would be best to replace it sooner rather than later," said Dr. Richardson.

"His appetite is healthy, and we are continuing to monitor him closely for an elevated temperature or other signs of discomfort."

The medical team at New Bolton Center has received several questions about Barbaro's care:

Q. Why was Barbaro's cast changed again?

A. For several days before the second cast change, Barbaro showed a slight elevation in body temperature and his hind legs appeared uncomfortable, which led to Dr. Dean Richardson's decision to reassess the leg and then change the cast. He was still not as comfortable as he had been so a new cast was applied on Wednesday.

Q. Why were two screws replaced and three new ones added?

A. Two previously implanted screws that cross the pastern joint were bent, so Dr. Richardson, who had predicted that bent screws in that area were likely, replaced them and added three new screws for additional support. Barbaro has been very active on his cast, and the repairs were needed as a result of force and motion in the affected area. The screws are bridging the pastern joint. They are not part of the repair of the primary fractures. The pastern joint needed to be fused because the proximal phalanx (long pastern bone) was so badly broken that the middle phalanx (short pastern bone) was needed to anchor the distal (lowest) part of the plate.

Q. What do the radiographs show about how well Barbaro is healing?

A. Barbaro's new radiographs show excellent progressive bone healing, a very positive sign.

Q. Were the repairs considered major surgery?

A. Barbaro was put under general anesthesia for the procedure. The repairs themselves were made under fluoroscopic control, which gives surgeons a live-X-ray view of the patient. This means that small one-centimeter incisions were made rather than any large incision.

Q. Did Barbaro have an abscess on his foot?

A. During the examination, doctors found a small infection on the sole of Barbaro's uninjured left hind hoof near the frog, a V-shaped cushiony growth that helps absorb shock. Dr. Richardson is treating the infection topically; in addition, Barbaro is on systemic antibiotics, which is common post-surgical practice. He also has a new protective shoe.

Q. What is laminitis and what are you doing to prevent it in Barbaro?

A. Laminitis is a painful condition in horses that can be the result of a number of causes, including excessive weight bearing in one limb. It occurs when laminae, the strong connecting tissues that attach the pedal bone and the inner hoof wall, are inflamed. Laminitis is very serious and can result in severe consequences. To reduce this risk, we applied a supportive shoe to Barbaro's left hind foot immediately following the surgery for the fracture of his right hind leg.
More on laminitis here

Q. How long will Barbaro have to stay in a cast?

A. Barbaro will remain in a cast until we believe that the fracture and joint fusions have developed adequate strength.

Q. How long will Barbaro remain in Intensive Care?

A. Barbaro will remain in the Intensive Care Unit at the George D. Widener Hospital as long as necessary. Even though he is progressing well and has not had major complications, he is not out of danger. Even if things progressed perfectly from this point forward, it is likely that he would be here two more months.



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